Time Zone: +2 hours. GMT +1 hour daylight savings time.
Tel. Country Code: 370
USADirect Tel.: 0
Electrical Standards: Electrical current is 220/50 (volts/hz). European Style Adaptor Plug. Grounding Adaptor Plug D.
TRAVEL ADVISORY - LITHUANIA
Europe, Russia and former the Soviet Union countries vary widely in travel risks and adequacy of health care delivery. Water- and food-borne illnesses such as travelers' diarrhea, typhoid and Giardia are threats outside of Western Europe. Insect-transmitted diseases, such as Lyme disease and tick-borne encephalitis are common in wooded, rural areas in most countries, including Western Europe.
• U.S. Embassy
Akmenu Gatve 6
Tel:  (5) 266-5500 or 266-5600
• Embassy of Canada
Jogailos St., 7th floor
Tel:  (5) 249-0950
Emergency toll-free to Ottawa: 88-003-0022
Fax:  (5) 249-7865
• British Embassy
Tel:  (5) 246 29 00
HIV Test: Required for applicants for permanent residence permits.
Required Vaccinations: None required.
Passport/Visa: Lithuania is a stable democracy undergoing rapid economic growth. Tourist facilities in Vilnius, the capital, and to a lesser extent in Kaunas and Klaipeda, are similar to those available in other European cities. In other parts of the country, however, some of the goods and services taken for granted in other countries may not be available.
ENTRY/EXIT REQUIREMENTS: A valid passport is required to enter Lithuania. As there are no direct flights from the U.S. to Lithuania, U.S. citizens should be aware of passport validity requirements in transit countries. American citizens do not need a visa to travel to Lithuania for business or pleasure for up to 90 days. That 90-day period begins with entry to any of the “Schengen group” countries: Austria, Belgium, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Italy, Latvia, Lithuania, Luxembourg, Malta, the Netherlands, Norway, Poland, Portugal, Slovakia, Spain, and Sweden. Multiple visits to Schengen countries may not exceed 90 days in any 6-åmonth period. Travelers remaining in Lithuania for more than 90 days within any six-month period must apply for temporary residency. All foreigners of non-European Union countries seeking entry into Lithuania must carry proof of a medical insurance policy contracted for payment of all costs of hospitalization and medical treatment in Lithuania. Visitors unable to demonstrate sufficient proof of medical insurance must purchase short-term insurance at the border from a Lithuanian provider for roughly $1.00 per day. Visit the Embassy of Lithuania web site at www.ltembassyus.org for the most current visa information.
VACCINATIONS: RECOMMENDED AND ROUTINE
Hepatitis A: Recommended for all travelers >1 year of age not previously immunized against hepatitis A.
Hepatitis B: Recommended for all non-immune travelers at potential risk for acquiring this infection. Hepatitis B is transmitted via infected blood or bodily fluids. Travelers may be exposed by needle sharing and unprotected sex; when receiving non-sterile medical or dental injections, or unscreened blood transfusions; by direct contact with open skin sores on an infected person. Recommended for long-term travelers, expatriates, and any traveler requesting protection against hepatitis B infection.
Influenza: Vaccination recommended for all travelers >6 months of age who have not received a flu shot in the previous 12 months.
Rabies: Rabies vaccine is recommended for: persons anticipating an extended stay; for those whose work or activities may bring them into contact with animals; for people going to rural or remote locations where medical care is not readily available; for travelers desiring extra protection.
Routine Immunizations: Immunizations against tetanus-diphtheria, measles, mumps, rubella (MMR vaccine) and varicella (chickenpox) should be updated, if necessary, before departure. MMR protection is especially important for any female of childbearing age who may become pregnant.
• The new Tdap vaccine, ADACEL, which also boosts immunity against pertussis (whooping cough) should be considered when a tetanus-diphtheria booster is indicated.
Typhoid: Recommended for all travelers with the exception of short-term visitors who restrict their meals to major restaurants and hotels.
HOSPITALS / DOCTORS
Medical care in Lithuania has improved in the last 15 years, but medical facilities do not always meet Western standards. There are a few private clinics with medical supplies and services that nearly equal Western European or U.S. standards. Most medical supplies are now widely available, including disposable needles, anesthetics, antibiotics and other pharmaceuticals. However, hospitals and clinics still suffer from a lack of equipment and resources. Lithuania has highly trained medical professionals, but their availability is decreasing as they leave for employment opportunities abroad. Not all doctors speak English,
• All travelers should be up-to-date on their immunizations and are advised to carry a medical kit as well as antibiotics to treat travelers’ diarrhea or other infections. Travelers who are taking regular medications should carry them properly labeled and in sufficient quantity to last for the duration of their trip; they should not expect to obtain prescription or over-the-counter drugs in local stores or pharmacies in this country—the equivalent drugs may not be available; may be of dubious origin; or of unreliable quality.
• Travelers are advised to obtain comprehensive travel insurance with specific overseas coverage, including medevac. In the event of a serious illness or injury that can't be treated locally every effort should be made to arrange medical evacuation to another country in Western Europe that has more advanced medical facilities.
The U.S. Embassy has a listing of doctors and hospitals at: http://vilnius.usembassy.gov/medical_information.html
Facilities in Vilnius include:
• Baltic-American Medical & Surgical Clinic
124 Antakalnio St.
Tel:  (2) 342 020
Most doctors and nurses are fluent in English and Russian. Full range of medical specialties. Only clinic in Lithuania which accepts foreign insurance from companies who pay directly to medical care providers.
• Medical Diagnostics Centre
V.Grybo g. 32/10
Tel:  (5) 270 91 20
• Med General Private Clinic
Gedimino pr. 1A-19
Tel:  (2) 613 534
English-speaking physicians; general practice and other specialties; lab and X-ray.
DESTINATION HEALTH INFO FOR TRAVELERS
AIDS/HIV: According to UNAIDS, over 1.5 million people were living with HIV in Eastern Europe and Central Asia at the end of 2007. After increasing steeply for several years, the number of new HIV diagnoses peaked in 2001 and then declined somewhat. The fall was due to a sharp drop in the number of cases amongst injecting drug users. However, the number of cases attributed to heterosexual contact has continued to rise - there were more than twice as many reports in 2007 as in 2002.
Of the new diagnoses of HIV reported in 2007, only 60% were reported with a transmission group. Of these, 62% were in injecting drug users, 37% were from heterosexual infections, and less than 1% were in men who have sex with men. The latter figure is probably artificially low due to homophobic discrimination making men unwilling to state how they were infected.
Injecting drug use has become unusually widespread amongst young people, especially young men. UNAIDS estimates that 1% of the population in the Russian Federation and other parts of the former Soviet Union is injecting drugs. Given the high odds of transmission through needle sharing, the fact that the young people are also sexually active, the lack of motivated HIV prevention work and the high levels of sexually transmitted infections in the wider population, a massive HIV & AIDS epidemic may be unavoidable.
UNAIDS estimates that HIV prevalence among adults exceeds 1% in Estonia, Ukraine, Moldova and Russia.
• UNAIDS estimates an HIV prevalence of 0.2% among adults in Lithuania. (Source: Avert.org)
• Transmission of HIV can be prevented by avoiding: sexual contact with a high-risk partner; injecting drug use with shared needles; non-sterile medical injections; unscreened blood transfusions.
• The threat of HIV/AIDS should not be a primary concern for the traveler. However, there may be a concern for a subset of travelers who may be exposed to HIV, the virus that causes AIDS, through contact with another person’s body fluids or blood. Although travel has contributed in a general way to the global spread of AIDS, fear of traveling because of this disease is not warranted.
Accidents & Medical Insurance:
Accidents and injuries are the leading cause of death among travelers under the age of 55 and are most often caused by motor vehicle and motorcycle crashes; drownings, aircraft crashes, homicides, and burns are lesser causes. Important safety rules to follow are 1) Do not drive at night, 2) Do not rent a motorcycle, moped, bicycle, or motorbike, even if you are experienced, and 3) Don't swim alone, at night, or if intoxicated.
• Heart attacks cause most fatalities in older travelers.
• Infections cause only 1% of fatalities in overseas travelers, but, overall, infections are the most common cause of travel-related illness.
• MEDICAL INSURANCE: Travelers are advised to obtain, prior to departure, supplemental travel health insurance with specific overseas coverage. The policy should provide for direct payment to the overseas hospital and/or physician at the time of service and include a medical evacuation benefit. The policy should also provide 24-hour hotline access to a multilingual assistance center that can help arrange and monitor delivery of medical care and determine if medevac or air ambulance services are required.
Diphtheria: There is risk of diphtheria in this country. All travelers, especially adults, should be fully immunized against diphtheria. A booster dose of a diphtheria-containing vaccine (Td or Tdap vaccine) should be given to those who have not received a dose within the previous 10 years.
Note: ADACEL is a new tetanus-diphtheria-pertussis (Tdap) vaccine that not only boosts immunity against diphtheria and tetanus, but has the advantage of also protecting against pertussis (whooping cough), a serious disease in adults as well as children.
European Tick-Borne Encephalitis (TBE): There is a risk of TBE throughout the country below 1,400 meters elevation. TBE is present in all districts of Lithuania. In 2003, the incidence rate was twice the average over the last ten years, and the highest annual rate recorded since the end of the 1960s. This rate was also the highest of all Baltic countries. Even though normally transmitted through a tick bite, 22 cases of TBE in 2003 were acquired by the consumption of unpasteurized goat milk – a well-known transmission route. The highest annual incidences of TBE, about 80% of all notified cases, have been recorded in the northern and central parts of the country, i.e., mainly in the counties Kaunas, Panevezys, and Siauliai. The highest incidence rate of TBE was recorded in Panevezys. The transmission season varies, however, ticks are most active during early spring to late autumn (March to November).
Source: Eurosurveillance: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=18916
• Travelers, especially those engaging in outdoor activities in rural areas, are advised to take measures to prevent tick bites during the peak transmission season, March to November. Tick-bite prevention measures include applying a DEET-containing repellent to exposed skin and permethrin spray or solution to clothing and gear.
• A map showing the distribution of TBE is here: http://www.nathnac.org/includes/contents/documents/TBEmap.gif
Hepatitis: All travelers not previously immunized against hepatitis A should be vaccinated against this disease. Hepatitis A is transmitted through contaminated food and water. Travelers who will have access to safe food and water are at lower risk. Those at higher risk include travelers visiting friends and relatives, long-term travelers, and those visiting areas of poor sanitation.
• Hepatitis E is endemic but levels are unclear. Sporadic cases may be underdiagnosed or underreported. Transmission of the hepatitis E virus (HEV) occurs primarily through drinking water contaminated by sewage and also through raw or uncooked shellfish. Farm animals, such as swine, and also deer and wild boar, may serve as a viral reservoirs. (HEV is one of the few viruses which has been shown to be transmitted directly from animals through food.) In developing countries, prevention of hepatitis E relies primarily on the provision of clean water supplies and overall improved sanitation and hygiene. There is no vaccine.
• The overall hepatitis B (HBsAg) carrier rate in the general population is estimated at 8% to 10%. Hepatitis B is transmitted via infected blood or bodily fluids. Travelers may be exposed by needle sharing and unprotected sex; from non-sterile medical or dental injections, and acupuncture; from unscreened blood transfusions; by direct contact with open skin lesions of an infected person. The average traveler is at low risk for acquiring this infection. Vaccination against hepatitis B is recommended for: persons having casual/unprotected sex with new partners; sexual tourists; injecting drug users; long-term visitors; expatriates, and anybody wanting increased protection against the hepatitis B virus.
• Hepatitis C is endemic at moderate levels. Most hepatitis C virus (HCV) is spread either through intravenous drug use or, in lesser-developed countries, through blood contamination during medical procedures. Over 200 million people around the world are infected with hepatitis C — an overall incidence of around 3.3% of the world’s population. Statistically, as many people are infected with HCV as are with HIV, the virus that causes AIDS.
Lyme Disease: This disease is prevalent in many European countries, including Lithuania. Risk of transmission occurs especially in rural brushy and forested areas. The ticks that transmit Lyme disease are most abundant and active April through September.
• Travelers, especially those engaging in outdoor activities in rural areas, such as campers and hikers, are advised to take measures to prevent tick bites during the peak transmission season. Tick-bite prevention measures include applying a DEET-containing repellent to exposed skin and permethrin spray or solution to clothing and gear. There is no vaccine against Lyme disease.
• A single 200-mg dose of doxycycline is effective in preventing Lyme disease if taken within 72 hours of being bitten by an infected tick. (Reference: http://content.nejm.org/cgi/content/abstract/345/2/79).
Other Diseases/Hazards: Raw cod (“lutefish”) in the Baltics may contain the fish tapeworm. Travelers are advised to avoid raw, smoked or undercooked fish.
Rabies: Occurs primarily in wild animals, especially foxes, in many rural areas of Europe. In Lithuania, most human rabies is related to bites from dogs, foxes, and raccoons. The risk to humans is low, but all animal bites should be medically evaluated.
Rabies vaccine is recommended for: persons anticipating an extended stay; for those whose work or activities may bring them into contact with animals; for people going to rural or remote locations where medical care is not readily available; for travelers desiring extra protection. Children are considered at higher risk because they tend to play with animals and may not report bites.
• Pre-exposure vaccination eliminates the need for rabies immune globulin, but does not eliminate the need for two additional booster doses of vaccine. Prompt medical evaluation and treatment of any animal bite is essential, regardless of vaccination status.
Travelers' Diarrhea: Low to moderate risk. Tap water should be avoided. A quinolone antibiotic, or azithromycin, combined with loperamide (Imodium), is recommended for the treatment of diarrhea. Diarrhea not responding to treatment with an antibiotic may be due to a parasitic disease, such as giardiasis or cryptosporidiosis.
Trichinellosis: An outbreak of trichinellosis due to wild boar meat was detected in Lithuania in June 2009. (Eurosurveillance Sep 2009) The outbreak affected 107 people all of whom had consumed sausages made of wild boar meat. Inspection of food samples confirmed the presence of Trichinella larvae in the meat.
Several human cases of trichinellosis are reported in Lithuania every year. Between 1999 and 2008, a total of 359 cases were registered, including 66 sporadic cases and 42 outbreaks.
Human trichinellosis in Lithuania is mostly spread by consumption of meat from infected pigs and wild boars. Of all outbreaks reported from 1999 to 2008, 58% occurred due to consumption of meat from home-raised pigs, 10% due to infected wild boar meat and about 8% due to illegal sale of meat. Some 24% of outbreaks were unexplained.
Trichinosis is infection with the roundworm Trichinella spiralis.
Symptoms: Abdominal discomfort, Cramping, Diarrhea, Fever, Muscle pain (especially muscle pain with breathing, chewing, or using large muscles).
Mebendazole or albendazole can be used to treat infections in the intestines. There is no specific treatment for trichinosis once the larvae have invaded the muscles. The cysts remain viable for years. Pain killers can help relieve muscle soreness.
Causes: Trichinosis is a disease caused by eating undercooked meat containing cysts of Trichinella spiralis. Trichinella spiralis can be found in pork, bear, walrus, fox, rat, horse, and lion meat. Wild animals, especially carnivores (meat eaters) or omnivores (animals that eat both meat and plants), should be considered a possible source of roundworm disease.
Prognosis: Most people with trichinosis have no symptoms and the infection goes away by itself. More severe infections may be more difficult to treat, especially if the lungs, the heart, or the brain is involved.
Prevention: Pork and meat from wild animals should be cooked until well done (no traces of pink). Freezing at subzero temperatures (Fahrenheit) for 3 to 4 weeks will kill the organism. Smoking, salting, or drying meat are not reliable methods of killing the organism that causes this infection.
Tuberculosis: Tuberculosis is highly endemic in Lithuania with an annual occurrence was greater than or equal to 40 cases per 100,000 population. Tuberculosis (TB) is transmitted following inhalation of infectious respiratory droplets. Most travelers are at low risk. Travelers at higher risk include those who are visiting friends and relatives (particularly young children), long-term travelers, and those who have close contact, prolonged contact with the local population. There is no prophylactic drug to prevent TB. Travelers with significant exposure should have PPD skin testing done to evaluate their risk of infection.
Typhoid Fever: Typhoid vaccine is recommended for all unvaccinated people traveling to or working in Eastern Europe, especially if visiting smaller cities, villages, or rural areas and staying with friends or relatives where exposure might occur through food or water. Current vaccines against Salmonella typhi are only 50-80% protective and do not protect against Salmonella paratyphi. (Paratyphoid fever bears similarities with typhoid fever, but the course is generally more benign.) Travelers should practice strict food, water and personal hygiene precautions even if vaccinated.